Therapy use for U.S. school-aged children with developmental disabilities: State variation and determinants.

The study is cross-sectional, so it can show associations but not cause and effect. Therapy use was parent-reported and combined speech, occupational, and behavioral therapy, so it cannot describe how much of each therapy was used or where it was delivered. Physical therapy was not explicitly included in the therapy measure, so parents may have underreported it. The sample included many different developmental disabilities and a wide age range, so findings may not apply to one condition or age group. Developmental disability status and therapy use were parent-reported, so they may have been underreported or overreported. Institutionalized children, who may use more therapy, were not included. The study did not know whether individual children were enrolled in a Medicaid waiver, so waiver findings are state-level. Some unmeasured factors may explain therapy use.

The authors declared no conflicts of interest.

Do not read the state differences or waiver-cost finding as proof that policies caused therapy use. The study was cross-sectional, used parent-reported combined therapy use, and did not measure physical therapy separately.